sodium bicarbonate

4.2%, 7.5%, 8.4% — Solution

Also known as: sodium bicarbonate soln 4.2%, 7.5%, 8.4% SODIUM BICARBONATE SOLN 8.4% sodium bicarbonate soln 4.2%, 8.4%

Informational only — Coverage rules change frequently; verify tier placement and restrictions with your plan or pharmacy before acting.

1 plan

Source: PDF · Formulary date: Apr 1, 2026 · Checked: 19 hours, 12 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
NC Medicaid Preferred Drug List 2026 via Konvomep	Non-Preferred	—	✓	—	ST

6 plans

Source: PDF · Formulary date: Apr 1, 2026 · Checked: 19 hours, 12 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
NC State Health Plan - 80/20 Plus PPO 2026	Tier 3 - Non-Preferred Brand	—	—	—	None
NC State Health Plan - 70/30 Standard PPO 2026	Tier 3 - Non-Preferred Brand	—	—	—	None
NC State Health Plan - HDHP 2026	Tier 3 - Non-Preferred Brand	—	—	—	None
NC State Health Plan - 80/20 Plus PPO 2026 via Konvomep	Not Covered	—	—	—	None
NC State Health Plan - 70/30 Standard PPO 2026 via Konvomep	Not Covered	—	—	—	None
NC State Health Plan - HDHP 2026 via Konvomep	Not Covered	—	—	—	None